Evaluation of the effect of surgical treatment on quality of life with the Dermatology Life Quality Index in patients with facial nonmelanoma skin cancer.

Skin cancers are the most common type of cancer. Nonmelanoma skin cancers (NMSCs) are more common than melanoma. Although the mortality rate is low, cancer word can be frightening for patients. Surgery is the main treatment. As skin cancers are most commonly located on the face, undesirable cosmetic results can occur as a result of treatments or due to primary disease. Therefore, the quality of life of patients could be affected. To determine the effect of surgical treatment on quality of life of the patients with facial NMSC using the Dermatology Life Quality Index (DLQI) at baseline and 3 months after surgery. We aimed to see if there was any improvement in quality of life scores after surgery, and to identify factors affecting quality of life. A total of 255 patients; 174 basal cell carcinoma (BCC) (68.2%) and 81 squamous cell carcinoma (SCC) (31.8%) were included in our study. All participants completed DLQI at baseline and 3 months after surgery. The mean total DLQI scores were 6.37 ± 6.28 in patients with BCC, and 6.35 ± 6.16 in patients with SCC. The mean total DLQI scores were 3.96 ± 5.14 in patients with BCC (P < .001), and 4.49 ± 5.24 in patients with SCC (P < .001) 3 months after surgery. In patients with primary skin cancer, all subscale scores and total DLQI scores were worse than the recurrent skin cancer group in both BCC and SCC at baseline. According to the treatment modalities, total DLQI scores and all subscales were worse in the graft group in BCC and SCC patients at baseline. Interestingly, the sex and the type of skin cancer did not affect quality of life, but tumor localization ([auricula OR: 6.45 [95% CI: 1.28-37.47] and eyelid OR:0.20 [95% CI: 0.04-0.96]) treatment procedure ([flap procedure OR: 7.90 [95% CI: 2.64-23.62] and graft procedure OR: 5.47 [95% CI: 1.60-18.71]) and, primary tumor OR:3.86 (95% CI: 1.01-14.78) were significant. The quality of life of skin cancer patients was affected by tumor localization, treatment procedure, primary, or recurrent tumor. The quality of life showed a significant improvement in patients with facial NMSC after surgical treatment. However, the type of NMSC seems to have no effect on the quality of life.

Chronic actinic damage of facial skin.

Chronic actinic damage of the skin manifests itself as extrinsic skin aging (photoaging) and photocarcinogenesis. During the last decade, substantial progress has been made in understanding cellular and molecular mechanisms of photoaging. DNA photodamage and ultraviolet-generated reactive oxygen species are the initial events that lead to most of the typical histologic and clinical manifestations of chronic photodamage of the skin. Chronic actinic damage affects all layers of the skin. Keratinocytes, melanocytes, fibroblasts, and endothelial cells are altered by ultraviolet radiation and can result in numerous changes in human skin, particularly the skin of fair-skinned individuals. These changes include actinic keratosis, thickening and wrinkling, elastosis, telengiectasia, solar comedones, diffuse or mottled hyperpigmentation, and skin cancers. There are many options in the treatment of changes caused by chronic actinic damage. The most effective measure of prevention of the photoaging and photocarcinogenesis is sun protection.

Comparison of the effects of Contractubex® gel in an experimental model of scar formation in rats: an immunohistochemical and ultrastructural study.

BACKGROUND: Contractubex® gel, a commercial treatment for scars, consists of a mixture of onion extract (cepea extract), heparin sodium, and allantoin. It exerts a softening and smoothing effect on indurated, hypertrophic, painful, and cosmetically-disfiguring scar tissue. AIM: To compare and discuss the immunohistochemical and ultrastructural effects of treatment of an experimental scar in a rat model with Contractubex gel. METHODS: Thirty-two Sprague-Dawley rats were divided into four groups. Skin biopsies were taken to develop full thickness wounds. After 10 days, Contractubex gel, heparin, and allantoin were topically applied daily to groups 2, 3, and 4, respectively. Group 1 was the control group. On the 30th day, scar tissues were excised to investigate the immunohistochemical and ultrastructural effects of these agents. For this purpose we used TGF-beta, laminin, and fibronectin primary antibodies. RESULTS: Increased immunoreactivities of laminin, fibronectin, and TGF-beta in control group, moderate immunoreactivities in heparin and allantoin groups, and mild immunoreactivities in the Contractubex gel group were observed. In semi-thin sections, Group 2 showed the thinnest epidermis of the four groups. In electron micrographs of Group 2, completely keratinized and normally appearing cells could be seen. CONCLUSIONS: Immunohistochemical and ultrastructural observations demonstrated that the Contractubex gel significantly improved the quality of wound healing and reduction of scar formation. Also, it was a more appropriate treatment choice than heparin monotherapy and allantoin monotherapy in keloidal and hypertrophic scars.

Nonsyndromic multiple basal cell carcinomas successfully treated with imiquimod 5% cream.

This report describes the case of a 60-year-old man with nonsyndromic multiple basal cell carcinomas that responded to imiquimod 5% cream. The patient had no additional anomalies suggesting any syndromes associated with multiple basal cell carcinomas. By applying the agent 5 times a week for 20 weeks, we obtained good clinical results, and we confirmed the improvement with histopathologic examination. We suggest that patients with multiple basal cell carcinomas should be interviewed about and tested for the associated syndromes, and topical imiquimod should be kept in mind as an alternative therapy choice in these patients.

A case report of postpubertal eruptive syringoma triggered with antiepileptic drugs.

Eruptive syringoma is a rare variant of syringoma, which typically occurs in large numbers as multiple yellow-brown colored papules. It usually presents before or during puberty. The pathogenesis of eruptive syringoma is unclear. It could represent a hyperplastic response of the eccrine ducts to an inflammatory reaction caused by an unknown trigger. The association between drugs and eruptive syringoma has not been reported in the literature until now. A 34-year-old woman with multiple asymptomatic papular eruptions of nine years' duration visited the authors' outpatient clinic. She had been using antiepileptic drugs for epilepsy for 10 years. Dermatological examination revealed multiple skin-colored to brownish papules, 1-3 mm in diameter, on the trunk and neck. Skin biopsy was performed from a lesion on the neck. According to clinical and histopathological findings, the patient was diagnosed as having eruptive syringoma. This case is very interesting, because the patient had been using antiepileptic drugs for a long time and the onset of her lesions was in postpubertal period. The authors' hypothesize that her lesions occured due to antiepileptics which may be a trigger of syringomatous proliferation. The authors conclude that drugs, especially antiepileptics, should be kept in mind in reference to the etiology of eruptive syringomas.

Childhood Pityriasis rosea inversa without Herald Patch Mimicking Cutaneous Mastocytosis.

BACKGROUND: Pityriasis rosea is a self-limited inflammatory condition of the skin that mostly affects young adults. Several less common atypical presentations have been reported. CASE PRESENTATION: A 6-year old girl with red-brown maculopapular eruption sized 0, 5-1 cm in diameter localized on neck, trunk and popliteal region visited our general pediatric outpatient clinic. The eruption was wide spread especially on flexural areas. After consulting dermatologist skin biopsy was performed. According to clinical and histopathological findings as inverse (flexural) pityriasis rosea was diagnosed. For treatment, systemic antihistamine, topical corticosteroid cream and emollient were applied. The lesions healed in two months. Spontaneous healing of the eruption also confirmed the diagnosis of pityriasis rosea. CONCLUSION: We present this interesting pediatric case to show and discuss pityriasis rosea, atypical presentations, differential diagnosis and the importance of dermatological examination and importance of dermatologic consultation for pediatric patients with skin eruption.

Acute generalized exanthematous pustulosis with lymphangitis triggered by a spider bite.

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous reaction pattern that, in the majority (>90%) of cases, is related to administration of medication. It can be seen in both genders and in all ages. The cutaneous manifestations of AGEP are usually seen 1-14 days after drug administration. A 39-year-old woman presented to our outpatient clinic with the complaint of generalized erythema, burning, and rash. She explained that 2 days before presentation a spider bite had occurred on her left forearm, after which she had experienced pain and erythema spreading gradually to the left upper extremity. On her dermatologic examination, she had an indurated necrotic plaque on the left forearm, which had an upward-spreading linear erythema. Additionally, she had diffuse erythema on her body and small pustules over erythematous skin, especially located on the left popliteal fossa and gluteal region. Based on the clinical and histopathologic findings, she was diagnosed as having AGEP. Because there was no drug use in her history, we attributed her AGEP lesions to the spider bite. This case is interesting, because the patient also had lymphangitis. Herein, we present the fifth case reported in the literature of AGEP caused by a spider bite.

Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey.

BACKGROUND: Dimeticone 4% lotion was shown to be an effective treatment for head louse infestation in two randomised controlled trials in England. It is not affected by insecticide resistance but efficacy obtained (70-75%) was lower than expected. This study was designed to evaluate efficacy of dimeticone 4% lotion in a geographically, socially, and culturally different setting, in rural Turkey and, in order to achieve blinding, it was compared with a potential alternative formulation. METHODS: Children from two village schools were screened for head lice by detection combing. All infested students and family members could participate, giving access to treatment for the whole community. Two investigator applied treatments were given 7 days apart. Outcome was assessed by detection combing three times between treatments and twice the week following second treatment. RESULTS: In the intention to treat group 35/36 treated using dimeticone 4% had no lice after the second treatment but there were two protocol violators giving 91.7% treatment success. The alternative product gave 30/36 (83.3%) treatment success, a difference of 8.4% (95% CI -9.8% to 26.2%). The cure rates per-protocol were 33/34 (97.1%) and 30/35 (85.7%) respectively. We were unable to find any newly emerged louse nymphs on 77.8% of dimeticone 4% treated participants or on 66.7% of those treated with the alternative formulation. No adverse events were identified. CONCLUSION: Our results confirm the efficacy of dimeticone 4% lotion against lice and eggs and we found no detectable difference between this product and dimeticone 4% lotion with nerolidol 2% added. We believe that the high cure rate was related to the lower intensity of infestation in Turkey, together with the level of community engagement, compared with previous studies in the UK. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10431107.

The relationship between symptoms and patient characteristics among psoriasis patients.

BACKGROUND: Pruritus is a common symptom of many dermatological and systemic diseases. It is a common complaint among patients with psoriasis of the chronic plaque type. Patients with pruritus suffer from more severe psoriasis although some authors did not find a significant relationship between pruritus intensity and psoriasis severity. AIMS: In this study, we aimed to investigate the relationship between clinical features and symptoms among psoriasis patients. And also we aimed to evaluate whether the severity of disease, depression and quality of life scores could effect these symptoms or not. METHODS: Eighty seven patients with psoriasis were enrolled in this study. Epidemiological data of patients were noted. Clinical symptoms, such as pruritus, pain, burning, exudation, bleeding, weakness, etc. were interrogated. The answers to these questions were classified as 'never', 'rare', 'sometimes', 'often' and 'all the time'. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hamilton Anxiety-Depression Scale (HAD) were calculated for each patient. PASI and DLQI scores were classified as > or = and < 10. RESULTS: We found that the most frequent symptom was pruritus (96.6%). Other frequent symptoms were burning (56.3%), exudation (56.3%) and bleeding (49.4%). Hurting, sensitiveness and bothering were more frequent in women. Percentages of hurting, pain, exudation and weakness symptoms had been increasing with age. Frequency of weakness was significantly high in PASI > or = 10 patients. CONCLUSION: Pruritus is a very common symptom in psoriasis. Burning, exudation and bleeding are also common symptoms seen in psoriasis. New scoring systems including symptoms of psoriasis patients may be developed for evaluating the severity of the disease.

Sorafenib-induced erythema multiforme in metastatic renal cell carcinoma.

Sorafenib is a new therapeutic agent being used in metastatic renal cell carcinoma, hepatocellular carcinoma, and malignant melanoma. The most frequently seen cutaneous side effects due to sorafenib are erythema, exfoliative dermatitis, acne vulgaris, and flushing. Folliculitis, eczema, and erythema multiforme are other, rare side effects of sorafenib. A 59-year-old man underwent left radical nephrectomy due to renal cell carcinoma 8 months ago, and after the operation he received immunochemotherapy and then sorafenib. On the third day of sorafenib therapy his lesions occurred. His dermatologic examination revealed multiple erythematous papules on his neck, arms, and legs and bullae and iris lesions on his palms and soles. He was diagnosed as having erythema multiforme. In the literature we found only 1 other erythema multiforme case due to sorafenib. We present this interesting case to show and discuss cutaneous side effects of sorafenib, especially erythema multiforme as a very rare cutaneous side effect.

Comparison of two combs in the detection of head lice in school children.

The diagnostic efficacies of two metal pin lice combs having different spacing between their teeth were compared in two cohorts of school children, aged between 7 and 15 years, from different villages of Manisa, Turkey. Head lice infestation was evaluated with comb A (0.18 mm of distance between the teeth) in 95 children in Cavusoglu village, and with comb B (0.15 mm of distance between the teeth) in 146 children in Yesilköy village, compared to visual inspection. Five of 95 (5.3%) children in Cavusoglu village and 5 of 146 (3.4%) children in Yesilköy village were found to harbor live head lice with combing, while none was detected during the visual inspection. The difference between the infestation rates of two cohorts was statistically insignificant (p > 0.05). With visual screening, 15 and 16 children with louse eggs were identified in Cavusoglu and Yesilköy villages, respectively. With combing in these villages, 5 and 8 children, respectively, with louse eggs were identified and 3 and 5 children, respectively, were detected only with combing, not with visual screening. In conclusion, combing is more effective than visual inspection in head lice detection, but there were no significant difference between the two combs either in lice detection or in usage.

Calciphylaxis with recalcitrant ulcers in the presence of moderate renal insufficiency.

A 69-year-old woman with painful crural ulcers of 3 months' duration presented at the authors' outpatient clinic. Dermatological examination revealed a necrotic ulceration with eschar formation localized on the anterior left crural region and the lateral malleolus of the right ankle. According to the clinical and histopathological findings, she was diagnosed with calciphylaxis. She had moderate renal insufficiency and secondary hyperparathyroidism due to hypertension. The ulcers improved significantly after 3 months of topical wound therapy. This case of calciphylaxis with recalcitrant ulcers in the presence of moderate renal insufficiency is presented to stress the importance of early diagnosis and management in this life-threatening disorder.

Comparison of the effects of collagenase and extract of Centella asiatica in an experimental model of wound healing: an immunohistochemical and histopathological study.

In this study, we compared the effects of collagenase and Centella asiatica in the rat model. Twenty-seven female rats were divided into three groups, and two full-thickness wounds were made for each animal. Collagenase ointment was applied topically to Group I and C. asiatica ointment to Group II rats. In Group III, no treatment was applied. On the third day of treatment, wounds on the left side of three animals of each group were excised. On the fifth and eighth day of the treatments, the same procedure was performed for the remaining animals. Indirect immunohistochemical examination was performed to detect transforming growth factor beta (TGF)-beta, endothelial and inducible nitric oxide synthase (eNOS and iNOS), vascular endothelial growth factor, TGF-alpha, laminin, fibronectin, collagen I, and interleukin-1beta. According to the measurements of the wound areas and wound healing periodo, collagenase was superior to the control group. Immunohistochemical examinations showed strong (+++) iNOS and TGF-beta immunoreactivities in C. asiatica group. eNOS immunoreactivity was moderate (++) in this group. For the collagenase group, iNOS, eNOS, and TGF-beta immunoreactivities were moderate (++). In the collagenase group, while TGF-beta and iNOS immunoreactivities were weaker, laminin and fibronectin reactivities were stronger than in C. asiatica and control groups. Collagenase was superior to C. asiatica according to the immunohistochemical findings. Collagenase ointment significantly improves the quality of wound healing and scar formation and is a more appropriate treatment choice than extract of C. asiatica in the early stages of the wound healing process.